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NPI Code Detail

MEDICARE: OCEAN DENTAL OF ARKANSAS, PC

MEDICARE: OCEAN DENTAL OF ARKANSAS, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1548302524
Entity Type Code : Organization
Provider Name (Legal Business Name) : OCEAN DENTAL OF ARKANSAS, PC
Provider Business Mailing Address
First Line : 206 W 6TH AVE
Second Line :
City : STILLWATER
State : OK
Zip : 74074-4017
Country : US
Telephone Number : 405-707-0600
Fax Number :
Provider Business Practice Location Address
First Line : 1326 S WALDRON RD
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-2556
Country : US
Telephone Number : 479-484-0008
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. CHAD BRANDON HOECKER
Credential : DDS
Telephone Number : 405-707-0600
Provider Enumeration Date : 02/13/2007
Last Update Date : 12/03/2007

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